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NPI Code Detail

MEDICARE: SOPHIE AMELIA SIDMAN FNP

MEDICARE: SOPHIE AMELIA SIDMAN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse PractitionerRN323929GA

General Provider Information

NPI Number : 1871398859
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIE AMELIA SIDMAN FNP
Provider Business Mailing Address
First Line : 1000 JOHNSON FERRY RD
Second Line : ATTN MANAGED CARE DEPT# 10-905
City : ATLANTA
State : GA
Zip : 30342
Country : US
Telephone Number : 404-256-8500
Fax Number : 404-256-8506
Provider Business Practice Location Address
First Line : 6135 BARFIELD RD STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30328-4308
Country : US
Telephone Number : 404-256-8500
Fax Number : 404-256-8506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2025
Last Update Date : 04/27/2026

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